Options for Regulation of Unregistered Health Practitioners

Consultation Forum

Background

Government reports have identified concerns about public protection with services provided by unregistered health practitionersNSW established a regulatory scheme for unregistered health practitioners in 2007 & the South Australian Parliament has passed legislationIn Feb 2010 Australian Health Workforce Ministerial Council agreed to a national consultation regarding regulation of unregistered health practitioners

Who has an interest?

Unregistered health practitioners, professional associations and union and industry bodies Registered health practitioners who practise outside the typical scope of practice of their professionConsumers of health services provided by the above two groupsEducation providersService providing agencies

Aim of National Consultation

To consider :

If there is a need for strengthened regulatory protection for consumers who use the services of unregistered health practitioners?

If there is a need for further protection, how should it be structured and administered?

Context

Establishment of the National Registration and Accreditation Scheme

COAG agreement for a ‘Seamless National Economy’

COAG ‘Best Practice Regulation’ requirements

Current regulatory arrangements

Laws governing registered health practitioners (Health Practitioner Regulation National Law Act) protect the public by:

probity checking all new entrants to these professions

powers to deal with impaired, incompetent or unethical practitioners

No similar protections for unregistered health practitioners

Current regulatory arrangements

Health complaints regulation arrangements vary between States and Territories

all have powers to receive, investigate, and conciliate or resolve complaints from consumers about health service providers

more extensive powers in NSW & (shortly) in South Australia

Current Regulation

Consumer Protection RegulationAustralian Consumer Law 1 Jan 2011

Unconscionable conductMisleading or deceptive conductFalse or misleading representations Power to grant injunctions and issue notices/orders

Range of other regulatory protections:public health risks therapeutic goods regulationdrugs and poisons regulationradiation equipment and use

Current Regulation

NSW regulation of unregistered health practitioners

‘negative licensing’ regulatory model Code of Conduct provides the basis for effective enforcement of standards of conduct and practicecommunicates these standards to practitioners and consumersprovides mechanism for investigation and prosecution

Risk to the Public

Vast majority of health practitioners are competent and caringA small number practise in a way that presents risks to the publicMany examples of unprofessional conduct:

lack of qualifications to support safe practicefailure to observe proper infection controlfailure to refer on appropriatelymaking unsubstantiated claims about the benefits of a treatment

Risks to the Public

– sexual or improper relationship with a client– financial exploitation – placing the public at risk due to physical or

mental impairment– practising under the influence of alcohol or

unlawful drugs– advising or encourage patients to cease

conventional treatments– breaching the privacy of a patient– misuse of herbal medicines or

pharmaceutical drugs

Options

Option 1: No Change

Option 2: Strengthen self-regulation – voluntary code of practice

Option 3: Strengthen health complaints mechanisms – statutory code of conduct

Option 1: No Change

Rely on existing regulatory and non-regulatory mechanisms

Professions able to make a case to governments for statutory registration at any time

Statutory code of conduct in some States and not in others

Option 1

Possible costsFailure to deal effectively and timely with unethical practitioners

Harm to consumers as a result.

Consequences of Inconsistency between States.

Possible benefitsNo new regulatory costs

States can regulate as they wish

Possible extension of statutory registration to other health practitioners

Option 2: Voluntary Code of Practice

Code/s may be tailored to each profession or occupation

Cooperative development of a national code of practice

Professional associations responsible for monitoring observance of code of practice and reporting on complaints and outcomes

Option 2 Possible costs

Lack of consensus in some professions may make implementation difficult Voluntary and therefore non-binding on rogue or bogus practitionersMay be ineffective in protecting the public in some cases

Possible benefitsFlexible standards that are able to be adapted if need arises Professional associations able to take the lead in educating members and enforcing standardsProvides guidance and education to practitioners and consumers on standards of practice

Option 3: Statutory Code of Conduct

Nationally consistent and enforceable statutory code of conduct for all unregistered health practitioners

Provides complaints mechanism for dealing with breaches of professional and ethical standards in health care whether the practitioner is registered or not

Minimal government intervention – only when breaches occur

Option 3 Possible costs

Requires new or amending legislation Need for new regulator or existing regulator to take on additional functions.Costs associated with investigation and prosecution of breaches of the Code of Conduct

Possible benefits Enforceable standards regardless of registration status Less costly to the community than registration of all practitioners Nationally consistent standardsStrengthened public protection and early intervention

Option 3

Two possible administrative mechanisms:

A single national administered by existing State and Territory complaints entities

A single national scheme administered by a new national complaints entity

Questions

Do you think there is a problem?

Do you think there is a need for further protection for consumers?

What do you think of the three options?

Do you have a preferred option?

Questions – cont’d

How important is national uniformity?

Should there be a single national Code of Conduct?

If you prefer option three, how should a scheme be administered – by existing State & Territory health complaints entities or a new national health complaints entity?

Questions – cont’d

Do you have any other comments about the proposals?

Further information

Contact:Glenys Sleeman Tel: 03 9096 1160

Glenys.Sleeman@health.vic.gov.au OR

Anne-Louise Carlton Tel: 03 9096 7610 Anne-Louise.Carlton@health.vic.gov.auOR

Naomi Hebson Tel: 07 3234 0862 Naomi_Hebson@health.qld.gov.au